|
INCISION OF TOE TENDON
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 28232
|
| Hospital Charge Code |
9822823201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$506.97 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Aetna of VT Commercial |
$650.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$506.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$506.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$582.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$575.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$548.00
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$548.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$548.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$548.00
|
| Rate for Payer: Multiplan Commercial |
$637.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$582.25
|
| Rate for Payer: United Healthcare Commercial |
$650.75
|
|
|
INCISION OF TOE TENDON
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
9602801002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$385.59 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna of VT Commercial |
$494.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$437.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$416.80
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.80
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.85
|
| Rate for Payer: United Healthcare Commercial |
$494.95
|
|
|
INCISION OF TOE TENDON
|
Facility
|
OP
|
$2,274.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
9602801001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,007.15 |
| Max. Negotiated Rate |
$2,160.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,160.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,037.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,007.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,037.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,368.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,932.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,841.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,023.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,807.83
|
| Rate for Payer: Cash Price |
$1,137.00
|
| Rate for Payer: Cigna Commercial |
$1,819.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,819.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,819.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,023.30
|
| Rate for Payer: Multiplan Commercial |
$2,114.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,932.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,023.30
|
| Rate for Payer: United Healthcare Commercial |
$2,160.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,023.30
|
| Rate for Payer: United Healthcare VA CCN |
$1,023.30
|
|
|
INCISION OF TOE TENDON
|
Facility
|
OP
|
$1,754.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
5102801001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$776.85 |
| Max. Negotiated Rate |
$1,666.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,666.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,571.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$776.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,571.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,055.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,490.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,420.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$789.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,394.43
|
| Rate for Payer: Cash Price |
$877.00
|
| Rate for Payer: Cigna Commercial |
$1,403.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,403.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,403.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$789.30
|
| Rate for Payer: Multiplan Commercial |
$1,631.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,490.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$789.30
|
| Rate for Payer: United Healthcare Commercial |
$1,666.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$789.30
|
| Rate for Payer: United Healthcare VA CCN |
$789.30
|
|
|
INCISION OF TOE TENDON
|
Professional
|
Both
|
$2,274.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
9602801001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$202.08 |
| Max. Negotiated Rate |
$2,137.56 |
| Rate for Payer: Aetna of VT Commercial |
$2,137.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,037.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,037.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$232.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$419.76
|
| Rate for Payer: Cash Price |
$1,137.00
|
| Rate for Payer: Cash Price |
$1,137.00
|
| Rate for Payer: Cigna Commercial |
$381.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$367.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$367.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$226.16
|
| Rate for Payer: Multiplan Commercial |
$2,114.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.08
|
| Rate for Payer: United Healthcare Commercial |
$310.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.08
|
| Rate for Payer: United Healthcare VA CCN |
$202.08
|
|
|
INCISION OF TOE TENDON
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 28232
|
| Hospital Charge Code |
9822823201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$303.39 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Aetna of VT Commercial |
$650.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$613.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$303.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$613.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$412.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$582.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$554.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$308.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$544.58
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$548.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$548.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$548.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$308.25
|
| Rate for Payer: Multiplan Commercial |
$637.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$582.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$308.25
|
| Rate for Payer: United Healthcare Commercial |
$650.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$308.25
|
| Rate for Payer: United Healthcare VA CCN |
$308.25
|
|
|
INCISION OF TOE TENDON
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
5102801001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.08 |
| Max. Negotiated Rate |
$1,648.76 |
| Rate for Payer: Aetna of VT Commercial |
$1,648.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,571.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,571.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$232.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$419.76
|
| Rate for Payer: Cash Price |
$877.00
|
| Rate for Payer: Cash Price |
$877.00
|
| Rate for Payer: Cigna Commercial |
$381.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$367.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$367.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$226.16
|
| Rate for Payer: Multiplan Commercial |
$1,631.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.08
|
| Rate for Payer: United Healthcare Commercial |
$310.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.08
|
| Rate for Payer: United Healthcare VA CCN |
$202.08
|
|
|
INCISION OF TOE TENDON
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
CPT 28232
|
| Hospital Charge Code |
9822823201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$232.59 |
| Max. Negotiated Rate |
$643.90 |
| Rate for Payer: Aetna of VT Commercial |
$643.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$613.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$239.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$613.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$325.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$640.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$640.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$267.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$640.41
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$441.44
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$577.05
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$577.05
|
| Rate for Payer: Martins Point Health Care Commercial |
$356.57
|
| Rate for Payer: Multiplan Commercial |
$637.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$330.28
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$232.59
|
| Rate for Payer: United Healthcare Commercial |
$357.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.59
|
| Rate for Payer: United Healthcare VA CCN |
$232.59
|
|
|
INCISION OF TOE TENDON
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
9822801001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna of VT Commercial |
$494.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$230.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$313.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.19
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.45
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.45
|
| Rate for Payer: United Healthcare Commercial |
$494.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.45
|
| Rate for Payer: United Healthcare VA CCN |
$234.45
|
|
|
INCISION OF TOE TENDON
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
9822801001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$385.59 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna of VT Commercial |
$494.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$437.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$416.80
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.80
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.85
|
| Rate for Payer: United Healthcare Commercial |
$494.95
|
|
|
INCISION OF TOE TENDON
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
9822801001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$202.08 |
| Max. Negotiated Rate |
$489.74 |
| Rate for Payer: Aetna of VT Commercial |
$489.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$208.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$282.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$419.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$419.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$232.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$419.76
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$381.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$367.21
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$367.21
|
| Rate for Payer: Martins Point Health Care Commercial |
$226.16
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$286.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$202.08
|
| Rate for Payer: United Healthcare Commercial |
$310.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.08
|
| Rate for Payer: United Healthcare VA CCN |
$202.08
|
|
|
INCISION OF TOE TENDON
|
Facility
|
IP
|
$1,754.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
5102801001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,298.14 |
| Max. Negotiated Rate |
$1,666.30 |
| Rate for Payer: Aetna of VT Commercial |
$1,666.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,298.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,298.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,490.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,473.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,403.20
|
| Rate for Payer: Cash Price |
$877.00
|
| Rate for Payer: Cigna Commercial |
$1,403.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,403.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,403.20
|
| Rate for Payer: Multiplan Commercial |
$1,631.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,490.90
|
| Rate for Payer: United Healthcare Commercial |
$1,666.30
|
|
|
INCISION OF TOE TENDONS
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
9822801101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna of VT Commercial |
$494.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$230.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$313.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$422.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$234.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$414.19
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$234.45
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$234.45
|
| Rate for Payer: United Healthcare Commercial |
$494.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.45
|
| Rate for Payer: United Healthcare VA CCN |
$234.45
|
|
|
INCISION OF TOE TENDONS
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
9822801101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$385.59 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna of VT Commercial |
$494.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$385.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$385.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$442.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$437.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$416.80
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$416.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$416.80
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$442.85
|
| Rate for Payer: United Healthcare Commercial |
$494.95
|
|
|
INCISION OF TOE TENDONS
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
9822801101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$270.57 |
| Max. Negotiated Rate |
$569.18 |
| Rate for Payer: Aetna of VT Commercial |
$489.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$278.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$466.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$378.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$569.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$569.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$311.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$569.18
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$510.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$496.30
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$496.30
|
| Rate for Payer: Martins Point Health Care Commercial |
$304.93
|
| Rate for Payer: Multiplan Commercial |
$484.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$384.21
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$270.57
|
| Rate for Payer: United Healthcare Commercial |
$416.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$270.57
|
| Rate for Payer: United Healthcare VA CCN |
$270.57
|
|
|
INCISION OF URETHRA
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
9815302002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$198.42 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna of VT Commercial |
$425.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$198.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$269.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$380.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$362.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.16
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$358.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$416.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$380.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$425.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$201.60
|
| Rate for Payer: United Healthcare VA CCN |
$201.60
|
|
|
INCISION OF URETHRA
|
Facility
|
IP
|
$2,684.04
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
4505302001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,986.46 |
| Max. Negotiated Rate |
$2,549.84 |
| Rate for Payer: Aetna of VT Commercial |
$2,549.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,986.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,986.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,281.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,254.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,147.23
|
| Rate for Payer: Cash Price |
$1,342.02
|
| Rate for Payer: Cigna Commercial |
$2,147.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,147.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,147.23
|
| Rate for Payer: Multiplan Commercial |
$2,496.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,281.43
|
| Rate for Payer: United Healthcare Commercial |
$2,549.84
|
|
|
INCISION OF URETHRA
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
9815302001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$198.42 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna of VT Commercial |
$425.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$198.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$269.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$380.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$362.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.16
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$358.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$416.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$380.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$425.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$201.60
|
| Rate for Payer: United Healthcare VA CCN |
$201.60
|
|
|
INCISION OF URETHRA
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
9815302002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$331.56 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna of VT Commercial |
$425.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$331.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$331.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$380.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$358.40
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$358.40
|
| Rate for Payer: Multiplan Commercial |
$416.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$380.80
|
| Rate for Payer: United Healthcare Commercial |
$425.60
|
|
|
INCISION OF URETHRA
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
9815302002
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$421.12 |
| Rate for Payer: Aetna of VT Commercial |
$421.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.50
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$156.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$416.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.00
|
| Rate for Payer: United Healthcare Commercial |
$138.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.00
|
| Rate for Payer: United Healthcare VA CCN |
$90.00
|
|
|
INCISION OF URETHRA
|
Facility
|
OP
|
$2,684.04
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
4505302001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,188.76 |
| Max. Negotiated Rate |
$2,549.84 |
| Rate for Payer: Aetna of VT Commercial |
$2,549.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,404.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,188.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,404.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,615.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,281.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,174.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,207.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,133.81
|
| Rate for Payer: Cash Price |
$1,342.02
|
| Rate for Payer: Cigna Commercial |
$2,147.23
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,147.23
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,147.23
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,207.82
|
| Rate for Payer: Multiplan Commercial |
$2,496.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,281.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,207.82
|
| Rate for Payer: United Healthcare Commercial |
$2,549.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,207.82
|
| Rate for Payer: United Healthcare VA CCN |
$1,207.82
|
|
|
INCISION OF URETHRA
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
9815302001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$421.12 |
| Rate for Payer: Aetna of VT Commercial |
$421.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.50
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$156.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$416.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.00
|
| Rate for Payer: United Healthcare Commercial |
$138.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.00
|
| Rate for Payer: United Healthcare VA CCN |
$90.00
|
|
|
INCISION OF URETHRA
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
9815302001
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$331.56 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna of VT Commercial |
$425.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$331.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$331.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$380.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$376.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$358.40
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$358.40
|
| Rate for Payer: Multiplan Commercial |
$416.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$380.80
|
| Rate for Payer: United Healthcare Commercial |
$425.60
|
|
|
INCISION OF URETHRA
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
9825302001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$421.12 |
| Rate for Payer: Aetna of VT Commercial |
$421.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$229.50
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$156.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$148.64
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$148.64
|
| Rate for Payer: Martins Point Health Care Commercial |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$416.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$90.00
|
| Rate for Payer: United Healthcare Commercial |
$138.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.00
|
| Rate for Payer: United Healthcare VA CCN |
$90.00
|
|
|
INCISION OF URETHRA
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
9825302001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$198.42 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna of VT Commercial |
$425.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$198.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$269.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$380.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$362.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$356.16
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cigna Commercial |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$358.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$358.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$416.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$380.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$425.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$201.60
|
| Rate for Payer: United Healthcare VA CCN |
$201.60
|
|
